- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.14 / $12.13 / $17.55
| Facility | | $6.14 | $12.13 | $17.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.18 / $5.05 / $9.94
| Professional | | $4.18 | $5.05 | $9.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $3.34 / $3.34
| Professional | | $3.34 | $3.34 | $3.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.48 / $17.36 / $25.73
| Facility | | $15.48 | $17.36 | $25.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.60 / $9.34 / $9.34
| Professional | | $5.60 | $9.34 | $9.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.67 / $7.17 / $30.64
| Facility | | $3.67 | $7.17 | $30.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $7.74 / $24.00
| Professional | | $3.50 | $7.74 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.05 / $5.05 / $14.60
| Facility | | $5.05 | $5.05 | $14.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $4.11 / $11.36
| Professional | | $2.34 | $4.11 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $3.34 / $11.59
| Professional | | $2.34 | $3.34 | $11.59 |